{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T15:03:03Z","timestamp":1785250983311,"version":"3.55.0"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2026,7]]},"abstract":"\n Objectives<\/jats:title>\n \n To evaluate whether nodal maximum standardised uptake value (SUV\n max<\/jats:sub>\n ) improves the positive predictive value (PPV) of prostate\u2010specific membrane antigen (PSMA) positron emission tomography (PET)\/computerised tomography (CT) for detecting lymph node invasion (LNI) in prostate cancer (PCa), and to develop clinical decision tools to guide decision\u2010making for patients with low\u2010 and high\u2010volume nodal disease.\n <\/jats:p>\n <\/jats:sec>\n \n Patients and Methods<\/jats:title>\n \n This international multicentre study included patients with histopathologically confirmed PCa who underwent preoperative PSMA\u2010PET and robot\u2010assisted radical prostatectomy with extended pelvic lymph node dissection (2016\u20132023). Sensitivity, specificity, PPV, and negative predictive value (NPV) for LNI detection were calculated, defining a positive test as non\u2010physiological PSMA uptake classified according to the Prostate Cancer Molecular Imaging Standardised Evaluation (PROMISE) molecular imaging Tumour\u2010Node\u2010Metastasis (miTNM) system. Receiver operating curves analysis identified optimal nodal SUV\n max<\/jats:sub>\n cut\u2010offs for pelvic LNI. Logistic regression assessed predictors for pathological N1 stage (pN1) and high\u2010volume nodal disease (four or more positive nodes). Clinical decision tools were developed to stratify patients into three risk groups for pN1 and high\u2010volume nodal disease.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 521 patients were included, with a median (interquartile range) age of 66\u2009(61\u201371)\u2009years and prostate\u2010specific antigen (PSA) level of 9.9\u2009(6.6\u201317.0)\u2009ng\/mL. The PSMA\u2010PET showed 45.0% sensitivity, 94.3% specificity, 64.7% PPV, and 88.3% NPV for LNI detection. Adding nodal SUV\n max<\/jats:sub>\n \u22654.9 improved the PPV to 81.1% and sensitivity to 71.4% and, combined with a PSA level \u226510\u2009ng\/mL, magnetic resonance imaging (MRI) T\u2010stage \u2265T3a, and miT\u2010stage \u2265T3a, identified 95% of pN1 cases in the high\u2010risk group. High\u2010volume nodal disease was found in 3.8%, including 1.1% in miN0 patients. Nodal SUV\n max<\/jats:sub>\n \u22657.2, MRI T\u2010stage \u2265T3a, and miN2 (multiple suspicious LNs) were predictors for high\u2010volume nodal disease and, combined in a clinical decision tool, excluded all low\u2010risk patients for high\u2010volume nodal disease.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Nodal SUV\n max<\/jats:sub>\n improves PPV of PSMA\u2010PET for nodal staging and aids in excluding high\u2010volume nodal disease. Clinical decision tools integrating nodal SUV\n max<\/jats:sub>\n with relevant clinical parameters demonstrate potential to guide individualised nodal management. These findings warrant external validation in larger cohorts.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/bju.70293","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T10:03:36Z","timestamp":1776679416000},"page":"133-143","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Nodal maximum standardised uptake value improves\n PSMA<\/scp>\n \u2010\n PET<\/scp>\n \/\n CT<\/scp>\n \u2010based nodal staging in intermediate\u2010 and high\u2010risk prostate cancer"],"prefix":"10.1111","volume":"138","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9991-6988","authenticated-orcid":false,"given":"Alexandra S.","family":"Bruins Slot","sequence":"first","affiliation":[{"name":"Department of Urology St. Antonius Hospital Nieuwegein\/Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera","family":"Sweere","sequence":"additional","affiliation":[{"name":"Department of Urology St. Antonius Hospital Nieuwegein\/Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joris G.","family":"Heetman","sequence":"additional","affiliation":[{"name":"Department of Urology St. Antonius Hospital Nieuwegein\/Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rick","family":"Hermsen","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine Canisius Wilhelmina Hospital Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lieke","family":"Wever","sequence":"additional","affiliation":[{"name":"Department of Urology St. Antonius Hospital Nieuwegein\/Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jules","family":"Lavalaye","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine St. Antonius Hospital Nieuwegein\/Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten","family":"Vinken","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine Canisius Wilhelmina Hospital Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0484-801X","authenticated-orcid":false,"given":"Clinton D.","family":"Bahler","sequence":"additional","affiliation":[{"name":"Department of Urology Indiana University Medical Center Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Tann","sequence":"additional","affiliation":[{"name":"Department of Radiology and Imaging Sciences Indiana University Medical Center Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Kesch","sequence":"additional","affiliation":[{"name":"Department of Urology, University Hospital Essen Essen German Cancer Consortium (DKTK) University Hospital Essen Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tugce","family":"Telli","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine University Hospital Essen Essen Germany"},{"name":"West German Cancer Center (WTZ) Essen Germany"},{"name":"German Cancer Consortium (DKTK) Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang P.","family":"Fendler","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine University Hospital Essen Essen Germany"},{"name":"West German Cancer Center (WTZ) Essen Germany"},{"name":"German Cancer Consortium (DKTK) Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1499-8372","authenticated-orcid":false,"given":"Peter Ka\u2010Fung","family":"Chiu","sequence":"additional","affiliation":[{"name":"S. H. Ho Urology Centre, Department of Surgery The Chinese University of Hong Kong Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwan Kit","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine and PET Hong Kong Sanatorium and Hospital Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Zattoni","sequence":"additional","affiliation":[{"name":"Urological Unit, Department of Surgery, Oncology, and Gastroenterology University of Padova Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Evangelista","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences Humanitas University Milan Italy"},{"name":"Division of Nuclear Medicine IRCCS Humanitas Research Hospital Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Ceci","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine and Theranostics IEO European Institute of Oncology, IRCCS Milan Italy"},{"name":"Department of Oncology and Hemato\u2010Oncology University of Milan Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"Miszczyk","sequence":"additional","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center Medical University of Vienna Vienna Austria"},{"name":"Collegium Medicum \u2013 Faculty of Medicine WSB University D\u0105browa G\u00f3rnicza Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4073-6584","authenticated-orcid":false,"given":"Pawel","family":"Rajwa","sequence":"additional","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center Medical University of Vienna Vienna Austria"},{"name":"Second Department of Urology Centre of Postgraduate Medical Education Warsaw Poland"},{"name":"Division of Surgery and Interventional Science University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3324-762X","authenticated-orcid":false,"given":"Akihiro","family":"Matsukawa","sequence":"additional","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center Medical University of Vienna Vienna Austria"},{"name":"Department of Urology The Jikei University School of Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tam\u00e1s","family":"Fazekas","sequence":"additional","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center Medical University of Vienna Vienna Austria"},{"name":"Department of Urology Semmelweis University Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Barletta","sequence":"additional","affiliation":[{"name":"Division of Oncology\/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute Vita\u2010Salute San Raffaele University Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Briganti","sequence":"additional","affiliation":[{"name":"Division of Oncology\/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute Vita\u2010Salute San Raffaele University Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7267-4181","authenticated-orcid":false,"given":"Francesco","family":"Montorsi","sequence":"additional","affiliation":[{"name":"Division of Oncology\/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute Vita\u2010Salute San Raffaele University Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5052-721X","authenticated-orcid":false,"given":"Giorgio","family":"Gandaglia","sequence":"additional","affiliation":[{"name":"Division of Oncology\/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute Vita\u2010Salute San Raffaele University Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean\u2010Paul A.","family":"Van Basten","sequence":"additional","affiliation":[{"name":"Department of Urology Canisius Wilhelmina Hospital Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harm H. E.","family":"Van Melick","sequence":"additional","affiliation":[{"name":"Department of Urology St. Antonius Hospital Nieuwegein\/Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roderick C. N.","family":"Van den Bergh","sequence":"additional","affiliation":[{"name":"Department of Urology Erasmus Medical Center Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giancarlo","family":"Marra","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgical Sciences, Molinette Hospital Citt\u00e0 della Salute e della Scienza and University of Turin Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo F. W.","family":"Soeterik","sequence":"additional","affiliation":[{"name":"Department of Urology St. Antonius Hospital Nieuwegein\/Utrecht The Netherlands"},{"name":"Department of Radiation Oncology University Medical Center Utrecht Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthijs J. V.","family":"Scheltema","sequence":"additional","affiliation":[{"name":"Department of Urology St. Antonius Hospital Nieuwegein\/Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the European Association of Urology\u2010Young Academic Urologists (EAU\u2010YAU) Prostate Cancer Working Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2017.12.048"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2023.03.001"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semnuclmed.2023.02.006"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000000531"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-020-04974-w"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.7150\/thno.18421"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-020-04944-2"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.15710"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-60099-y"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-019-04524-z"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-024-06847-y"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2007.07.035"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11701-024-01881-2"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2010.160"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.02800"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.54.7893"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-022-06089-w"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2023.02.002"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euo.2023.03.010"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2011.10.044"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.13540"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.4103\/iju.iju_143_24"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12149-024-01957-x"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-017-3631-6"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2016.09.007"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41391-022-00544-3"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41585-021-00497-7"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2024.01.012"},{"key":"e_1_2_10_30_1","first-page":"6.e1","article-title":"How accurate is 68Gallium\u2010prostate specific membrane antigen positron emission tomography\/computed tomography (68Ga\u2010PSMA PET\/CT) on primary lymph node staging before radical prostatectomy in intermediate and high risk prostate cancer? A study of patient","volume":"40","author":"Erdem S","year":"2022","journal-title":"Urol Oncol Semin Orig Investig"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euros.2022.12.011"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13550-024-01152-z"}],"container-title":["BJU International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bju.70293","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/bju.70293","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bju.70293","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T11:29:58Z","timestamp":1780918198000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/10.1111\/bju.70293"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,20]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1111\/bju.70293"],"URL":"https:\/\/doi.org\/10.1111\/bju.70293","archive":["Portico"],"relation":{},"ISSN":["1464-4096","1464-410X"],"issn-type":[{"value":"1464-4096","type":"print"},{"value":"1464-410X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,20]]},"assertion":[{"value":"2026-04-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}